Department of Rheumatology, University Hospital of Besançon, boulevard Fleming, 25030 Besançon Cedex, France.
Expert Rev Clin Immunol. 2014 Feb;10(2):281-94. doi: 10.1586/1744666X.2014.870036. Epub 2013 Dec 18.
The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.
本文旨在综述冷冻疗法在炎症性风湿病（治疗和生物学效应）中的现有证据。对于治疗效果，我们进行了系统评价（PubMed、EMBASE、Cochrane 图书馆、LILACS 数据库、未发表数据），并选择了包括非手术和非感染性关节炎患者接受局部冷冻疗法或全身冷冻疗法治疗的研究。通过汇总包括 257 例类风湿关节炎（RA）患者的 6 项研究，我们表明慢性冷冻疗法后 RA 患者的疼痛视觉模拟评分（mm）和 28 关节疾病活动评分显著降低。对于分子途径，局部冷冻疗法会导致关节内温度降低，这可能会下调几个参与关节炎症和破坏的介质（细胞因子、软骨降解酶、促血管生成因子），但在 RA 中的研究很少。冷冻疗法应作为辅助治疗纳入 RA 治疗策略，具有潜在的皮质类固醇和非甾体抗炎药剂量节约效应。然而，在具有更强方法学的随机对照试验中，应更精确地定义技术和方案。
